- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $3,162.28 / $9,332.54
| Facility | | $630.96 | $3,162.28 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $371.54 / $794.33
| Professional | | $309.03 | $371.54 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $4,365.16 / $10,232.93
| Facility | | $1,621.81 | $4,365.16 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $416.87 / $831.76
| Professional | | $295.12 | $416.87 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $1,071.52 / $2,754.23
| Facility | | $331.13 | $1,071.52 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $489.78 / $1,148.15
| Professional | | $323.59 | $489.78 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $1,258.93 / $3,981.07
| Facility | | $302.00 | $1,258.93 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $389.05 / $741.31
| Professional | | $275.42 | $389.05 | $741.31 |